tbuckley/cabot-search huggingface dataset:
Abstract P635: Poverty, Sodium Intake and Abnormal Blood Pressure Among Youth 13 to 18 Years of Age
Authors: Carissa M Baker-Smith, Robert E Akins, Shannon Lennon, Christian Alvarado
Journal: Circulation (2023)

Hypertension (HTN) is a primary cause of cardiovascular disease (CVD) and begins in youth. Among adults, low socioeconomic status (SES) is a demonstrated risk factor for HTN. Low SES has been associated with increased sodium intake and obesity. In this study, we assess the impact of family income, obesity and sodium intake during adolescence on average systolic blood pressure (SBP) to determine if these factors are associated with HTN and elevated BP during adolescence. Methods: Using 2007-2018 National Health and Nutrition Examination Survey data, representative of the non-institutionalized civilian population 13 to 18 years of age, we employed multivariable logistic regression (proc survey logistic) to assess the relationship between abnormal BP diagnosis (HTN or elevated BP), family income, obesity, and sodium intake. Poverty was defined as a family income less than 5-times the poverty level. Sodium intake was estimated based upon a combined 1-day total dietary and 1-day diet supplement recall and was adjusted for total caloric intake per day. The upper quartile of adjusted sodium intake was used to distinguish high from low sodium intake. Abnormal BP was defined as an average systolic blood pressure (SBP) at or above 120mmHg. Multivariable logistic regression was carried out. Results: 2.4% and 13% of the adolescent population had average SBP at or above 130mmHg (HTN) or at or above 120mmHg (elevated BP), respectively. According to multivariable logistic regression, predictors of the HTN/Elevated BP were overweight status (OR: 2.4, 95%CI: 1.8, 3.2), obesity (OR: 3.6 95%CI: 2.8, 4.7), male sex (OR:3.6, 95%CI: 2.7, 4.9), non-Hispanic black race (OR: 1.8, 95%CI: 1.2, 1.4) and age (OR: 1.3, 95%CI: 1.2, 1.4). Poverty status (OR: 1.2, 95%CI: 0.74, 1.9), Hispanic ethnicity (OR 1.2, 95%CI: 0.87, 1.5), and sodium intake (OR: 1.1, 95%CI: 0.86, 1.4) were not associated with HTN/elevated BP. Conclusion: While SES factors contribute to abnormal BP, sodium intake and family income were not associated with HTN/elevated BP in adolescents using a single day dietary intake recall. According to our results, additional SES factors contribute to HTN/elevated BP in adolescents and should be further explored.
Abstract MP09: Diets Varying in Glycemic Index and Carbohydrates With Meal-Timing Specific 12-hour Postprandial Metabolic Changes: The Omnicarb Trial
Authors: Xuan Wang, Hao Ma, Yoriko Heianza, Lawrence J Appel, Frank M Sacks, Lu Qi
Journal: Circulation (2023)

Background: Both the glycemic index (GI) and amounts of carbohydrates are important determinants of postprandial glucose changes. Recent studies suggest the effects of carbohydrate intake on postprandial glucose metabolism may differ according to meal timing, showing circadian patterns. Hypothesis: We investigated whether the relations of altering both GI levels and the carbohydrate amount with postprandial response of glucose, insulin, and c-peptide differed by meal timing (breakfast, lunch, and dinner), in overweight and obese adults. Methods: The OmniCarb trial was a randomized trial with a crossover design in which participants were given 4 diets varying in GI levels and carbohydrate content. We included 61 participants attended the 12-h postprandial study and completed at least two diets. Area under the curve increment (AUCi) of glucose, insulin, and c-peptide after breakfast (180 min), lunch (240 min), and dinner (120 min), was calculated as outcome. Results: After consuming each diet for 5 weeks, we observed that the diet replacing effects on the postprandial responses in glucose, insulin and c-peptide significantly differed by meal timing. For postprandial glucose response to breakfast, the beneficial effects (lowered AUCi) of replacing high- by low-GI in high-carb diet, replacing high- by low-carb in high-GI diet, and replacing high-GI/high-carb by low-GI/low-carb diet were consistently observed. Such beneficial effects were less significant for lunch and dinner (Figure). For the response of insulin, the beneficial effects of the corresponding diet replacements were more consistently observed in dinner, followed by breakfast. For the response of C-peptide, similar beneficial effects of the corresponding diet replacements were observed for breakfast and dinner, but not lunch. Conclusion: Our results indicate that the beneficial effects of replacing high-GI and/or high-carbohydrate diets by low-GI and/or low-carbohydrate diets on postprandial metabolic changes may differ according to meal timing.
Abstract P527: Epidemiology of Adverse Childhood Experiences and Cardiometabolic Risks
Authors: Tyra Dark, Jacob Chernicky, Rachel Harris
Journal: Circulation (2023)

Purpose: Adverse Childhood Experiences (ACEs) have been linked to a wide range of adverse health outcomes. The purpose of this research is to better understand this association and elucidate the mechanisms by which ACEs influence cardiometabolic (CM) risk factors (blood pressure, BMI, pre-diabetes). Racial/ethnic distribution of ACEs and potential health outcomes were also examined. Methods: This study utilized data from the Florida Behavioral Risk Factor Surveillance System for the 2019-2021 survey years to examine the racial/ethnic distribution of ACEs and cardiometabolic risks. Results: A total of 13,198 participants were included in this study with non-Hispanic Whites representing 76% of the study population. The highest percentage of each racial/ethnic group reported two or fewer ACEs. The Multiracial non-Hispanic group tended to have higher percentages of reported ACEs. The association between ACEs and CM risk factors significantly differed across racial/ethnic groups.
Abstract P521: Association Between Dietary Phytosterols and Risk of Cardiovascular Disease Mortality in US Adults: Findings From the Third National Health and Nutrition Examination Survey (NHANES III), 1988-1994
Authors: Julianah O Oguntala, Andreea Zurbau, Meaghan E Kavanagh, Andrea Glenn, Laura Chiavaroli, Tauseef A Khan, Sonia Blanco Meija, David J Jenkins, Cyril Kendall, John L Sievenpiper
Journal: Circulation (2023)

Introduction: Phytosterols (plant sterols) are naturally occurring components of plant food sources, including vegetable oils, nuts, cereals and legumes. Their chemical structure impedes intestinal cholesterol absorption and regular consumption has been related to lower serum low-density cholesterol (LDL-C), a causal risk factor for cardiovascular disease (CVD). The association between dietary plant sterol intake and CVD has yet to be determined. Objective: We aimed to examine the association of phytosterol consumption in the diet with cardiovascular mortality in US adults the National Health &amp; Nutrition Examination Survey III (NHANES III), 1988-1994. Methods: We conducted a prospective cohort analysis on National Health and Nutrition Examination Survey (NHANES, 1988-1994 [III]), linked with the National Death Index mortality data (2015) to associate dietary phytosterol intake from 24h dietary recall data with CVD mortality. We included 13,004 adults aged ≥20 years who were non-pregnant, free of CVD at baseline and completed ≥1 24h dietary recall with plausible caloric intake data. We excluded individuals with death occurring within 1 year of baseline. We created a database quantifying the phytosterol content of foods in the 24h dietary recall data and estimated usual intake by quintiles using the NCI method. We determined the risk function by regression calibration and estimated CVD mortality risk between the 10 th (Q1) and 90 th (Q5) percentiles of usual intake. Data was adjusted for sex, age, smoking status and ethnicity. Results: Over a mean±SD follow-up period of 21.2±5.1y, 949 CVD deaths occurred in a population with a mean±SD age of 44.2±14.3y, BMI 26.7±4.7 kg/m 2 and mean dietary plant sterol usual intake of 272.3 mg/day. The top sources of dietary phytosterols were from potatoes 23%), wheat and other grains (21%) and beans, legumes and nuts (13%). Mean usual intake plant intake in the 10 th (Q1) and 90 th (Q5) percentiles of the population was 150.1 and 414.0 mg/day. The estimated relative risk for CVD mortality between Q1 (ref) and Q5 was 0.972 (p&lt;0.05). Conclusions: Preliminary analyses suggest a CVD death risk reduction of 2.8% in the highest versus lowest intakes of dietary plant sterols in the US population. We plan to expand the multivariable model to include the Healthy Eating Index (diet quality) and assess stratification by healthful and unhealthful sources of phytosterols and linear and non-linear dose response analyses to determine the robustness of the association. OSF Registration: osf.io/da4sg Funding: Amgen Scholars Program, Canadian Institutes of Health Research (CIHR), Banting and Best Diabetes Centre (BBDC), Toronto 3D Knowledge Synthesis and Clinical Trials foundation
Abstract P537: Abnormal Serum Potassium is Associated With Risk of Cardiovascular Disease in Patients With Chronic Kidney Disease
Authors: Jenilee C Cueto, Andrei R Stefanescu, Samantha O'Connell, Hua He, Jing Chen, Morgan Grams, Amanda H Anderson, Jiang He, Katherine T Mills
Journal: Circulation (2023)

Introduction: Patients with chronic kidney disease (CKD) are at an increased risk of cardiovascular disease (CVD) compared to the general population. The role that abnormal serum potassium plays in the risk of CVD in patients with CKD is unclear. Our objective is to examine the association of hypokalemia and hyperkalemia with risk for cardiovascular events in patients with CKD. Methods: Data from 3,939 patients from the Chronic Renal Insufficiency Cohort (CRIC) Study, a multicenter cohort study of patients with CKD, were used. Cumulative average serum potassium collected annually prior to CVD events was calculated. Hypokalemia (&lt;3.5 mmol/L) and hypokalemia (&gt;5.0 mmol/L) were compared to normokalemia (3.5 - 5.0 mmol/L). Composite CVD was defined as congestive heart failure (CHF), stroke, myocardial infarction (MI), and atrial fibrillation (afib). Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) and were adjusted for age, gender, race/ethnicity, education, study site, body mass index, cigarette smoking, alcohol use, physical activity, history of diabetes, hypercholesteremia, and CVD, baseline use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, use of diuretics, use of other antihypertensive medication, and baseline eGFR. Results: Participants had a median age of 59.0 years and were 55% male, 42% Non-Hispanic White, and 42% Non-Hispanic Black. The prevalence of hypokalemia and hyperkalemia was 2.5% and 6.4%, respectively. Median follow-up was 9.2 years for composite CVD. Hypokalemia and hyperkalemia are both significantly associated with composite CVD, CHF, MI, and afib when compared to normokalemia (Table). Conclusions: We found significant associations between abnormal serum potassium and CVD in patients with CKD. Interventions to maintain normokalemia in patients with CKD could potentially reduce the risk of CVD in this high-risk population.
Abstract P516: Multilevel Factors Are Related to Blood Pressure in Native Hawaiian Communities
Authors: Claire T Ing, Hyeong Jun Ahn, Joseph K Kaholokula, Peter Hovmand, Todd B Seto, Rachel Novotny
Journal: Circulation (2023)

The association between blood pressure and cardiovascular disease events (e.g., stroke, heart attack) is continuous, consistent, and independent. Hypertension prevalence is 55% among Native Hawaiians, the indigenous people of Hawai‘i, compared to 23% among Whites. Native Hawaiians have high rates of physical inactivity and poor diet. Discrimination and acculturation have been associated with blood pressure in Native Hawaiians. Household characteristics (e.g., food insecurity) have been linked to hypertension in Hawai‘i. Areas with high proportions of Native Hawaiians have more fast-food outlets. Limited research has been done to examine how multilevel factors impact blood pressure in this high-risk population. The purpose of this study was to examine the contribution of individual-level behavioral, biological, psychosocial; household-level; and community-level factors in explaining variability in systolic blood pressure (SBP) and diastolic blood pressure (DBP). Adult participants (n=150) were recruited from 6 predominantly Native Hawaiian communities across Hawai‘i. Height, weight, and blood pressure were measured using standardized protocols. Behavioral factors included consumption of foods measured by the NCI dietary screener questionnaire and physical activity category and sedentary time measured by the International Physical Activity Questionnaire. Psychosocial factors included cultural identity and perceived discrimination. Household factors included size, financial stability, and food insecurity. Community factors included neighborhood walkability. Sociodemographic factors were also assessed. Four multilevel models for SBP and DBP were developed. The level-1 model for both SBP and DBP included sociodemographic factors. The level-2 model for both SBP and DBP adds behavioral factors (e.g., BMI, physical activity, daily intake of diet components). The level-3 model adds financial stability, food insecurity for SBP and cultural identity and discrimination for DBP. The level-4 model adds walkability for SBP and financial stability, food insecurity, and family use of free school lunches for DBP. For SBP and DBP models, Akaike’s Information Criterion (AIC) decreased from 740.9 and 663.2 to 529.5 and 515.8, respectively, and Bayesian Information Criterion (BIC) decreased from 740.4 and 663.0 to 529.3 and 514.4, respectively. For SBP, each successive model produced a lower AIC and BIC, indicating that the inclusion of behavioral, household, and community factors improved the models’ ability to predict SBP. Similarly, for DBP, the inclusion of behavioral, psychosocial, and household-level factors improved the model's ability to predict DBP. These results illustrate the importance of including multilevel factors in research to understand and address hypertension and cardiovascular disease in Native Hawaiian communities.
Abstract P636: Burden of Atherosclerotic Cardiovascular Disease in Patients With versus Without Cancer: Insights From the Houston Methodist Cardiovascular Disease Learning Health System Registry
Authors: Izza Shahid, Nihan Farooq, Rakesh Gullapelli, Eleonora Avenatti, Jorge Carrasco Avila, Roshni Mandania, Aayush Shah, Sherif F Nagueh, Maan Malahfji, Jenny Chang, Khurram Nasir
Journal: Circulation (2023)

Background: Identifying cardiovascular burden in cancer patients is important for appropriate risk stratification. Despite this population-based analyses delineating the burden of cardiovascular disease (CVD) across the spectrum of atherosclerotic CVD (ASCVD) remain less well-established in patients with cancer. We aimed to evaluate and compare the burden of CVD in patients with vs without cancer. Methods: Houston Methodist Learning Health System Registry was utilized to obtain data of ∼1.1 million adult patients reporting in the outpatient department between 2016-2022. All patients with a cancer diagnosis listed on their problems list using the ICD-10 Clinical Modification codes (C00 -C96) were identified. Patients with ASCVD including CAD, PAD, and stroke, HF and AF were also identified using ICD 10-CM. Age-adjusted prevalence and multivariate logistic regression analyses were calculated to determine the burden and odds of CVD in patients with vs without cancer, respectively. Results: A total of 93,238 (8.7%) patients with cancer and 978,301 (91.3%) patients without cancer were included. Age-adjusted burden of ASCVD was higher amongst patients with cancer compared with patients without cancer (9.3 vs 8.2; p&lt;0.01). These results were consistent across the spectrum ASCVD, HF and AF. Multivariate analyses revealed significantly increased odds of ASCVD (OR 1.19 [1.17-1.22]), CAD (OR 1.21 [1.18-1.24]) PAD (OR 1.16 [1.12-1.21]), stroke (OR 1.15 [1.11-1.18]), HF (OR 1.59 [1.56-1.63]) and AF (OR 1.52 [1.49-1.56]) in patients with cancer compared with patients without cancer after adjusting for demographic characteristics. Conclusion: Despite recent therapeutic advancements improving mortality outcomes in patients with cancer, these patients incur a substantial burden of CVD across the spectrum of ASCVD when compared with patients without cancer. Pre-emptive prevention and appropriate risk stratification is important to understand the evolving health care needs of this high cardiovascular risk population.
Abstract P500: Age-Specific Population Attributable Fractions for the Impact of Hypertension on Dementia Risk
Authors: Jason Smith, A R Sharrett, James R Pike, Rebecca F Gottesman, David Knopman, Mark Lee, Pamela L Lutsey, Priya Palta, B Gwen Windham, Josef Coresh, Jennifer A Deal
Journal: Circulation (2023)

Introduction: Hypertension in midlife, but not late life, is a robust predictor of subsequent dementia. However, the fraction of dementia attributable to hypertension might vary depending on the age of the population considered, and the age through which dementia onset occurs. Here, we investigated associations of hypertension assessed at various ages with incident dementia by age 80 or 90, then estimated population attributable fractions (PAF) for dementia from hypertension categories at each of these age groups. Hypothesis: Given hypertension prevalence increases with age but its relative risk for dementia tends to decrease, we had no prior expectation of the age at which the PAF’s would be highest. We hypothesized, however, that PAFs for incident dementia would be higher when hypertension is measured in midlife age groups versus late-life age groups. Methods: We leveraged 32 years of follow-up data from the Atherosclerosis Risk in Communities study (ARIC), a prospective, community-based cohort that enrolled participants aged 45-64 years from four US communities (Washington County, MD; Forsyth County, NC; Jackson, MS; and selected suburbs of Minneapolis, MI) at ARIC visit 1 (1987-1989). Participants were followed through 2018-2019. We used Cox proportional hazards models to estimate hazard ratios, then quantified PAFs, of dementia by age 80 and 90 from hypertension assessed at ages of 45-54 (ARIC visit 1), 55-64 (ARIC visits 1 and 4), 65-74 (ARIC visits 4 and 5), and 75-84 (ARIC visit 5). Results: Hypertension was assessed among 7,572 participants aged 45-54; 12,033 aged 55-64; and 6,561 aged 65-74. By age 80 the number identified as having incident dementia was 711, 910, and 372, respectively. Relative to normotension, hypertension in each age category was associated with hazard ratios (HRs) greater than 1.0 for dementia from hypertension by age 80. The PAF for dementia by age 80 from hypertension measured at age 45-54 was 15.3% (95% CI = 6.9, 22.3%), 19.1% (95% CI = 9.9, 26.9%) at ages 55-64, and 19.9% (95% CI = -4.4, 38.5%) at ages 65-74. By age 90, the number of incident dementia cases were 958; 2,302; and 1,327, respectively; and, among the 2,086 participants aged 75-84, 400 incident dementia cases. HRs were slightly smaller than those by age 80, while hypertension assessed in the 75-84 age group was not significant. The PAFs for dementia by age 90 from hypertension at age 45-54 was 13.8% (95% CI = 6.6, 20.0%), 12.9% (95% CI = 7.0, 18.2%) at ages 55-64, 10.9% (95% CI = 0.02, 21.0%) at ages 65-74, and non-significant at ages 75-84. Conclusions: Public health interventions targeting hypertension in midlife through early late-life might reduce a sizeable proportion of dementia cases.
Abstract P502: Blood Pressure Variability and Neurodegenerative Biomarkers: The Multidomain Alzheimer Preventive Trial
Authors: Leonardo Bencivenga, Mathilde Strumia, Yves Rolland, Sandrine Andrieu, Bruno Vellas, Philipe de Souto Barreto, Laure Rouch
Journal: Circulation (2023)

Background: Increased Blood Pressure (BP) Variability (BPV) may represent an alteration in physiological homeostatic patterns, typical of late life, and has been associated with cerebrovascular disease, cognitive impairment and dementia, including Alzheimer’s disease. Accumulation of Brain beta amyloid (Aβ) and neurofilament light chain (NFL) release are typical biomarkers of neurodegeneration, whose assessment requires neuroimaging and cerebrospinal fluid (CFS) measurements, thus limiting their use in large-scale screening of the aging populations. Nevertheless, plasma Aβ42/40 ratio is associated with CSF Aβ42/40 ratio, similarly plasma NFL levels correlate with NFL in CFS. Furthermore, blood progranulin (PGL) is also considered a neurodegenerative biomarker, since deficiency exerts pleiotropic effects on the development, maintenance, stress response, and ageing of neural circuit. Objective: We aimed to explore the association of visit-to-visit BPV with blood concentrations of neurodegenerative biomarkers in a population of older adults. Methods: Participants were selected among community-dwelling participants aged ≥70 years from the Multidomain Alzheimer Preventive Trial (MAPT) Study. Plasma blood sample was collected 12 months after enrolment and BP was assessed every six months from enrollment (0, 6, 12 months). Systolic BPV (SBPV) and diastolic BPV (DBPV) were determined through several indicators considering BP change over time, the order of measurements and formulas independent of mean BP levels. Multivariable linear regressions were used to assess the association between visit-to-visit BPV and either PGL, Aβ42/40 and NFL. Results: The study population consisted of 470 participants (mean age 75.7 ± 4.5 years; female, 59.7%). Visit-to-visit BPV (all indicators, both systolic and diastolic) was not associated with blood levels of neurodegenerative biomarkers after adjustment for demographics, BMI, MAPT randomization group, education, baseline BP, antihypertensive drugs, diabetes mellitus, ischemic heart disease, atrial fibrillation, stroke: per 1-SD increase in systolic BPV (coefficient of variation %): Aβ42/40: adjusted β (SE) = -0.07 (0.04), p=0.13 and NFL: adjusted β (SE) = -0.06 (0.04), p=0.19. Conclusion: Neither systolic nor diastolic visit-to-visit BPV were associated with neurodegenerative blood biomarkers (Aβ42/40, NFL, and PGL) in a population of older adults. Further studies with longer-term assessment of BPV are needed.